Introduction
In this issue ...
· Changes in Chairmanship of Advisory Committees
· Definition of a "Request" in Surgical Histopathology
· Recruitment and Accreditation
· Call for Multi-lingual Inspectors!

As of 1 April 2001 the following changes apply:

We wish to thank the outgoing Chairmen, Dr David Williams, Dr Alan McDermott and Dr Stephen Jeffcoate for all their support over their term of office.

Stephen Jeffcoate was the inaugural Chairman for the CPA (EQA) Committee and has provided invaluable help in initiating accreditation of EQA Schemes within the UK.

It is now well established that pathology has recruitment and retention problems. The survey carried out on behalf of CPA (UK) Ltd, specifically within Histopathology, showed clearly the problems that that discipline has in attracting sufficient Doctors and Biomedical Scientists. The Institute of Biomedical Science survey looked specifically at Biomedical Scientist recruitment and retention across all disciplines in depth. The results made disturbing reading particularly at Grade 1 level. This received major publicity during the year and government responded recently in some respect by breaking its pay policy this year specifically for Trainee and Grade 1 Biomedical Scientists.

Nevertheless, we know that at the time of the IBMS Survey there was a 25% vacancy factor amongst Grade 1 staff, and that more than half of those vacancies were unable to be filled within a period of six months. It is really not difficult to see the reason why this problem has occurred. The current Biomedical Scientist staffing structure is basically a 'dinosaur' left over from a qualification and training system that was
ideal for the 1960's when the majority of recruitment occurred at age 16. It is now entirely inappropriate to attract the necessary science graduates particularly from the very popular accredited Biomedical Science degrees.

The recent additional pay awards for the starter grades will help but on its own is insufficient. To fully rectify the problem much depends upon the outcome of the recently launched 'Healthcare Scientists Plan' and the 'root and branch' job evaluation project that is nearing completion.

The obvious question to ask is of course: "If recruitment is such a problem how has the service been surviving?" The Institutes survey made disturbing reading in this respect.

· Time for training has in many laboratories gone.
· Low staff moral is universal.
· 25% of laboratories used agency non state registered individuals for Biomedical Scientist duties.
· Trainee Biomedical Scientists were working unsupervised - including on-call. 

· Experienced MLA staff were being used to fill in for missing Biomedical Scientists.
· Some laboratories were using MTO graded staff as Biomedical Scientists.


The common theme is of course that the work has to get done and somebody has to do it. Laboratory Business Managers are increasingly 'managing' the systems as best they can. The hard fact emerges that for service expediency because of the inability to recruit and retain staff, individuals who have not been educated and demonstrated competence to state registration level are being used as though they have.

Biomedical Science is a regulated profession. The State Registration System (CPSM) is clear that Biomedical Scientists require honours accredited degrees and to have undertaken audited training culminating in an end point examination. This applies not only to, individuals graded as Biomedical Scientists, but also to those carrying out the function of a Biomedical Scientist.

State registration cannot be side stepped by using other professionals, unless they as individuals have met the criteria for state registration.

The whole point of national quality and accreditation schemes is that they ensure standards of practice and competence that translate to any laboratory - in the interests of the patient.

The failure of the service to recruit and retain appropriately qualified staff cannot be used as an excuse to start the slippery slope back to local currency in laboratory practice standards. It was the fact that local variation in the education and competence of staff and service existed, that prompted the introduction of State Registration, quality control schemes and indeed CPA (UK) Ltd Accreditation.

To have local laboratory business managers attempting to justify, that an individual who has not achieved the educational and competence measures required for state registration, yet by local assessment and opinion are safe to act as though they have is a downward spiral that takes laboratory practice back half a century.

It is worrying that the evidence is there to suggest that the many varied employment grades within the Healthcare Scientist sector are poorly understood by the sector itself, let alone Trust management. Yet the NHS Executive is clear in its requirement for Trust conduct. Staff employed as biomedical scientists need to be state registered and there is the further requirement that private laboratories carrying out work on behalf of the NHS use state registered biomedical scientists.

It is probable that the local variation, which the IBMS Survey showed has started to emerge, would not be sanctioned by the Trust Board - if they fully understood the minefield of regulation for the sector and therefore the full implication for their pathology service.

Government's approach is clear. There is a commitment to extend state registration to most of the groups that are not currently covered. Clearly a key driver in this has been the recent poor media coverage that pathology has received. Now is not the time for biomedical scientists - the largest numerical group to drift backwards.

CPA (UK) Ltd standards are clear - pathology staff must be appropriately qualified. This means all professions and lowering the requirement on a local basis is not an acceptable solution to the recruitment and retention problems that are now being addressed by government by more appropriate means.

There are examples of laboratories using the pay scales of other professions as a mechanism for pay advancement for state registered biomedical scientists in order to redress the recruitment difficulties. This is of course an acceptable practice although probably frowned upon by the trades union. Just because individuals are paid using other grades does not mean they professionally become that grade. It is to a degree in the gift of local management to decide pay scales but not to decide educational and competence requirements.


Martin Nicholson
President, IBMS 

At a recent meeting of the UK Accreditation Forum, the Chairman, Dr Charles Shaw, asked if CPA had within its ranks any inspectors who were fluent in another language. He apparently has a number of contacts throughout the world asking for assistance from the UK. At the present time the major interest is from Russia. If you are fluent in another language and wish to be considered for this unholy task please contact Cheryl Blair at CPA Central Office.

Cytogenetics services are usually provided from regional laboratories each catering for a population of between 2 - 5 million. Most provide a comprehensive range of cytogenetics investigations and function independently from other pathology disciplines: some specialize in oncology and are based in Haematology departments. Cytogenetics and Molecular Genetics departments are often integrated into "Laboratory Genetics" services, liaising closely with the Clinical Genetics service. Indeed this integrated model forms the basis for the National Specialized Services definition set for a core genetics service.

Consultant Clinical Cytogeneticists direct the majority of Cytogenetics laboratories: they are graded as grade C Clinical Scientists. There are a few, smaller, laboratories in which the Head of Department is graded at the top of the B Grade (consistent with AL SP 1/90). The professional qualification for Clinical Cytogeneticists aspiring to the senior positions of their discipline is MRCPath, first introduced for Cytogeneticists in 1985.

The largest staff group delivering the Cytogenetics service is State Registered Clinical Scientists. An appointment to a Clinical Scientist post involves one or more DoH appointed national assessors with the requirement for both post and candidates to be assessed. The reliance on Clinical Scientists in genetics laboratories reflects the developmental nature of the service, with dependence on research, scientific and technical skills as well as responsibility for interpretation of results and clinical liaison. 

In 2000 Clinical Scientists comprised 72 % of the workforce (total 593.9 WTE, including 15 MLSO, 95.1 MTO and 53.2 MLA). This compares with 84% CS in 1994 (total 437.0 including 14.0 MLSO, 9.5 MTO, 44.5 MLA). The picture then is of an expanding workforce with a broadening skill mix.

The reasons for the gradual change in skill mix over the last decade have been varied. Cost efficiencies have played a part but, more importantly, the profession has recognized that many of the procedures have become protocol driven. Where previously Clinical Scientists worked at a combination of skill levels, this has become more refined, with the majority of technical functions and some analytical procedures now being performed by cytogenetics technologists, employed at MLA, ATO or MTO grades, according to job description and professional consensus. In 1996 a detailed analysis was undertaken by the ACC of the skills required in the cytogenetics laboratory to provide the full range of investigations(1). These were grouped into 5 skill levels defined by increasing complexity; each skill level assuming experience of and ability to perform the tasks listed at lower levels. For example, the tasks incorporated at skill level 1 include sample receipt, preparation of culture media, and harvesting of cell cultures, while task level 5 includes planning and control of budgets, as well as strategic planning. Cytogenetic technologists work up to and including skill level 2. This excludes cytogenetic technologists from undertaking clinical liaison, interpreting, reporting or validating results and from authorisation of interpretive reports. 

Unregistered (trainee) clinical cytogeneticists would be expected, always under supervision, to undertake clinical liaison, make decisions at pre-analytical, analytical and post analytical stages, including the clinical interpretation of results. Authorisation of clinical reports is normally carried out by Section Heads (or above) graded at or beyond B17 on the present Clinical Scientist pay spine.

State Registration is a measure of competence, a mechanism for providing proper protection for the public and patients. Technical support staff are not regulated through the Professions Supplementary to Medicine Act 1960 because of the limitations of the Act. The government has set in process a mechanism to ensure that professional regulation is developed and modernized with the creation of a new Health Professions Council to replace CPSM. The new legislation will provide a framework to facilitate the regulation of all 'Healthcare Scientists', this key milestone being achieved 'beyond 2004'(2).

In the meantime the ACC continues to develop and pilot the training programme for MTO staff. This is based on the draft National Occupational Standards Framework, ensuring competence-based training delivered by trained trainers and validated by trained assessors.

References: 

(1) ACC Working Party Report: Review of Staffing Structure in NHS Cytogenetics Laboratories 1996
(2) 
www.doh.gov.uk/makingthechange 
Dr Lorraine Gaunt
Chair of the Genetics SAC

 Full information can be obtained from CPA Central Office.

It is our aim to encourage discussion and audience participation at these training sessions and anyone attending should have read the standards and sent copies of any questions to CPA Central Office in advance. Standards can be downloaded from the CPA website at 
www.cpa-uk.co.uk 

At the present time we are on course for this timetable. Six pilot sites have been identified along with suitable inspectors.

Around September 2002 we intend to cease inspecting against the old standards. This will allow time to report back to departments already inspected and change the CPA database for the new standards. 

There will be a number of applicants due for second or subsequent cycle registration during the months October 2002 to March 2003. They will be offered one of two alternatives:

· Being reinspected early against the old standards 
· Having registration delayed to be inspected against the new standards

Central Office will be contacting these laboratories in due course.
Cheryl Blair

THE ROLE OF BIOMEDICAL SCIENTISTS IN THE SURGICAL CUT UP


The Royal College of Pathologists produced a set of draft guidelines on this matter and circulated them to all the Histopathologists in the country. An initial analysis of the responses indicated that 72% of respondents supported the proposals. In addition trainee Histopathologists were in favour of the development and CPA also gave its support.

In the light of this, these proposals, which have the support of the College Council and the Histopathology SAC, are now being recommended to Histopathology departments by both the College and CPA. 

They will be further discussed by the Pathology Alliance and the IBMS but departments that wish to implement the proposals are now encouraged to do so.

Any department that uses Biomedical Scientists in this way is advised to audit the process and inform the College and the IBMS of the outcome.

KWM Scott, Chairman of the Histopathology SAC